The Post Incarceration
Syndrome (PICS) is a serious problem that contributes to relapse in addicted and
mentally ill offenders who are released from correctional institutions.
Currently 60% of prisoners have been in prison before and there is growing
evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to
this high rate of recidivism. [i]

The concept of a post
incarceration syndrome (PICS) has emerged from clinical consultation work with
criminal justice system rehabilitation programs working with currently
incarcerated prisoners and with addiction treatment programs and community
mental health centers working with recently released prisoners.

This article will
provide an operational definition of the Post Incarceration Syndrome (PICS),
describe the common symptoms, recommend approaches to diagnosis and treatment,
explore the implications of this serious new syndrome for community safety, and
discuss the need for political action to reduce the number of prisoners and
assure more humane treatment within our prisons, jails, and correctional
institutions as a means of prevention.It
is my hope that this initial formulation of a PICS Syndrome will encourage
researchers to develop objective testing tools and formal studies to add to our
understanding of the problems encountered by released inmates that influence
recovery and relapse.

Post Incarceration
Syndrome (PICS) - Operational Definition

The Post Incarceration
Syndrome (PICS) is a set of symptoms that are present in many currently
incarcerated and recently released prisoners that are caused by being subjected
to prolonged incarceration in environments of punishment with few opportunities
for education, job training, or rehabilitation.The symptoms are most severe in prisoners subjected to prolonged solitary
confinement and severe institutional abuse.

The severity of
symptoms is related to the level of coping skills prior to incarceration, the
length of incarceration, the restrictiveness of the incarceration environment,
the number and severity of institutional episodes of abuse, the number and
duration of episodes of solitary confinement, and the degree of involvement in
educational, vocational, and rehabilitation programs.

The Post Incarceration
Syndrome (PICS) is a mixed mental disorders with four clusters of symptoms:

(1)Institutionalized Personality
Traits resulting from the common deprivations of incarceration, a chronic
state of learned helplessness in the face of prison authorities, and antisocial
defenses in dealing with a predatory inmate milieu,

(2)Post Traumatic Stress Disorder
(PTSD) from both pre-incarceration trauma and trauma experienced within the
institution,

(3)Antisocial Personality Traits (ASPT)
developed as a coping response to institutional abuse and a predatory
prisoner milieu, and

(5)Substance Use Disorders caused
by the use of alcohol and other drugs to manage or escape the PICS symptoms.

PICS often coexists
with substance use disorders and a variety of affective and personality
disorders.

Symptoms of the Post
Incarceration Syndrome (PICS)

Below is a more
detailed description of four clusters of symptoms of Post Incarceration Syndrome
(PICS):

1.Institutionalized Personality Traits

Institutionalized
Personality Traits are caused by living in an oppressive environment that
demands: passive compliance to the demands of authority figures, passive
acceptance of severely restricted acts of daily living, the repression of
personal lifestyle preferences, the elimination of critical thinking and
individual decision making, and internalized acceptance of severe restrictions
on the honest self-expression thoughts and feelings.

2.Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress
Disorder (PTSD) [ii]
is caused by both traumatic experiences before incarceration and institutional
abuse during incarceration that includes the six clusters of symptoms:(1) intrusive memories and flashbacks to episodes of severe institutional
abuse; (2) intense psychological distress and physiological reactivity when
exposed to cues triggering memories of the institutional abuse; (3) episodes of
dissociation, emotional numbing, and restricted affect; (4) chronic problems
with mental functioning that include irritability, outbursts of anger,
difficulty concentrating, sleep disturbances, and an exaggerated startle
response. (5) persistent avoidance of anything that would trigger memories of
the traumatic events; (6) hypervigilance, generalized paranoia, and reduced
capacity to trust caused by constant fear of abuse from both correctional staff
and other inmates that can be generalized to others after release.,

3.Antisocial Personality Traits

Antisocial Personality
Traits [iii][iv][v]are
developed both from preexisting symptoms and symptoms developed during
incarceration as an institutional coping skill and psychological defense
mechanism.The primary antisocial
personality traits involve the tendency to challenge authority, break rules, and
victimize others.In patients with
PICS these tendencies are veiled by the passive aggressive style that is part of
the institutionalized personality.Patients
with PICS tend to be duplicitous, acting in a compliant and passive aggressive
manner with therapists and other perceived authority figures while being capable
of direct threatening and aggressive behavior when alone with peers outside of
the perceived control of those in authority.This is a direct result of the internalized coping behavior required to
survive in a harshly punitive correctional institution that has two set of
survival rules:passive aggression with the guards, and actively aggressive
with predatory inmates.

4.Social-Sensory Deprivation Syndrome:

The Social-Sensory
Deprivation Syndrome [vi]
is caused by the effects of prolonged solitary confinement that imposes both
social isolation and sensory deprivation.These
symptoms include severe chronic headaches, developmental regression, impaired
impulse control, dissociation, inability to concentrate, repressed rage,
inability to control primitive drives and instincts, inability to plan beyond
the moment, inability to anticipate logical consequences of behavior, out of
control obsessive thinking, and borderline personality traits.

5.Reactive Substance Use Disorders

Many inmates who
experience PICS suffer from the symptoms of substance use disorders [vii].Many of these inmates were addicted prior to incarceration, did not
receive treatment during their imprisonment, and continued their addiction by
securing drugs on the prison black market.Others developed their addiction in prison in an effort to cope with the
PICS symptoms and the conditions causing them.Others relapse to substance abuse or develop substance use disorders as a
result of using alcohol or other drugs in an effort to cope with PICS symptoms
upon release from prison.

PICS Symptoms
Severity

The syndrome is most
severe in prisoners incarcerated for longer than one year in a punishment
oriented environment, who have experienced multiple episodes of institutional
abuse, who have had little or no access to education, vocational training, or
rehabilitation, who have been subjected to 30 days or longer in solitary
confinement, and who have experienced frequent and severe episodes of trauma as
a result of institutional abuse.

The syndrome is least
severe in prisoners incarcerated for shorter periods of time in rehabilitation
oriented programs, who have reasonable access to educational and vocational
training, and who have not been subjected to solitary confinement, and who have
not experienced frequent or severe episodes of institutional abuse.

Reasons To Be
Concerned About PICS

There is good reason to
be concerned because about 40% of the total incarcerated population (currently
700,000 prisoners and growing) are released each year.The number of prisoners being deprived of rehabilitation services,
experiencing severely restrictive daily routines, being held in solitary
confinement for prolonged periods of time, or being abused by other inmates or
correctional staff is increasing. [viii]

The effect of releasing
this number of prisoners with psychiatric damage from prolonged incarceration
can have a number of devastating impacts upon American society including the
further devastation of inner city communities and the destabilization of
blue-collar and middle class districts unable to reabsorb returning prisoners
who are less likely to get jobs, more likely to commit crimes, more likely to
disrupt families.This could turn
many currently struggling lower middle class areas into slums. [ix]

As more prisoners are
returned to the community, behavioral health providers can expect to see
increases in patients admitted with the Post Incarceration Syndrome and related
substance use, mental, and personality disorders.The national network of Community Mental health and Addiction treatment
Programs need to begin now to prepare their staff to identify and provide
appropriate treatment for this new type of client.

The nation's treatment
providers, especially addiction treatment programs and community mental health
centers, are already experiencing a growing number of clients experiencing the
Post Incarceration Syndrome (PICS).This
increase is due to a number of factors including: the increasing size of the
prisoner population, the increasing use of restrictive and punishing
institutional practices, the reduction of access to education, vocational
training, and rehabilitation programs; the increasing use of solitary
confinement and the growing number of maximum security and super-max type prison
and jails.

Both the number of
clients suffering from PICS and the average severity of symptoms is expected to
increase over the next decade.In
1995 there were 463,284 prisoners released back to the community.Based upon conservative projections in the growth of the prisoner
population it is projected that in the year 2000 there will be 660,000 prisoners
returned to the community, in the year 2005 there will 887,000 prisoners
returned to the community, and in the year 2010 1.2 million prisoners will be
released. [x]
The prediction of greater symptom severity is based upon the growing trend
toward longer periods of incarceration, more restrictive and punitive conditions
in correctional institutions, decreasing access to education, vocational
training, and rehabilitation, and the increasing use solitary confinement as a
tool for reducing the cost of prisoner management.

Clients with PICS are
at a high risk for developing substance dependence, relapsing to substance use
if they were previously addicted, relapsing to active mental illness if they
were previously mentally ill, and returning to a life of aggression, violence,
and crime.They are also at high
risk of chronic unemployment and homelessness.

Post Release Symptom
Progression

This is because
released prisoners experiencing PICS tend to experience a six stage post
release symptom progression leading to recidivism and often are not
qualified for social benefits needed to secure addiction, mental health, and
occupation training services.

·Stage 1 of this Post Release Syndrome is marked by Helplessness
and hopelessness due to inability to develop a plan for community reentry, often
complicated by the inability to secure funding for treatment or job training;

·Stage 2 is marked by an intense immobilizing fear;

·Stage 3 is marked by the emergence of intense free-floating anger
and rage and the emergence of flashbacks and other symptoms of PTSD;

·Stage 4 is marked by a tendency toward impulse violence upon
minimal provocation;

·Stage 5 is marked by an effort to avoid violence by severe
isolation to avoid the triggers of violence;

·Stage 6 is marked by the intensification of flashbacks,
nightmares, sleep impairments, and impulse control problems caused by
self-imposed isolation.This leads
to acting out behaviors, aggression, violence, and crime, which in turn sets the
stages for arrest and incarceration.

Currently 60% of
prisoners have been in prison before and there is growing evidence that the Post
Incarceration Syndrome (PICS) is a contributing factor to this high rate of
recidivism.

Reducing The
Incidence Of PICS

Since PICS is created
by criminal justice system policy and programming in our well intentioned but
misguided attempt to stop crime, the epidemic can be prevented and public safety
protected by changing the public policies that call for incarcerating more
people, for longer periods of time, for less severe offenses, in more punitive
environments that emphasize the use of solitary confinement, that eliminate or
severely restrict prisoner access to educational, vocational, and rehabilitation
programs while incarcerated.

The political antidote
for PICS is to implement public policies that:

(1)Fund the training and expansion of community based addiction and mental
health programs staffed by professionals trained to meet the needs of criminal
justice system clients diverted into treatment by court programs and released
back to the community after incarceration;

(2)Expand the role of drug and mental health courts that promote treatment
alternatives to incarceration;

(3)Convert 80% of our federal, state, and county correctional facilities
into rehabilitation programs with daily involvement in educational, vocational,
and rehabilitation programs;

(4)Eliminate required long mandated minimum sentences;

(5)Institute universal prerelease programs for all offenders with the goal
of preparing them to transition into community based addiction and mental health
programs;

(6)Assuring that all released prisoners have access to publicly funded
programs for addiction and mental health treatment upon release.